Tracheal necrosis following thyroid radiofrequency ablation.

INTRODUCTION: Radiofrequency ablation for benign thyroid nodules has a low rate of complications in experienced hands for selected indications, but tracheal necrosis is a major complication. CASE REPORT: A 60 year-old female patient underwent percutaneous radiofrequency ablation of an unesthetic benign isthmic thyroid nodule. The procedure was performed with a cooled electrode, using the "moving shot" technique on a trans-isthmic approach, under general anesthesia. Postoperative course was complicated by dysphonia and cervical pain implicating a third-degree skin burn of the medial cervical region progressing to severe soft-tissue and cervical tracheal necrosis. DISCUSSION: Risk factors in the present case included the general anesthesia, isthmic location and thyroid nodule volume. To avoid this kind of complication, the procedure should be performed under local anesthesia, using cooled dextrose solution hydrodissection between trachea, thyroid and skin. Ahead of radiofrequency ablation, patients should be informed of possible major complications, especially if the indication is cosmetic.

Percutaneous dilatational tracheostomy for saturating influx of COVID-19 patients: Experience of military ENT physicians deployed in Mulhouse, France.

OBJECTIVES: The main objective was to demonstrate the feasibility of percutaneous tracheostomy performed under difficult conditions by military ENT physicians during their deployment in the military intensive care field hospital of the French Military Medical Service in Mulhouse to confront the exceptional COVID-19 pandemic. The secondary objective was to assess reliability and safety for patient and caregivers, with a risk of iatrogenic viral contamination. MATERIAL AND METHODS: A single-center retrospective study was conducted between March 25 and April 25, 2020, in 47 COVID-19 patients requiring prolonged mechanical ventilation. The inclusion criterion was having undergone percutaneous tracheostomy. RESULTS: Eighteen consecutively included patients had successfully undergone percutaneous tracheostomy despite unfavorable anatomical conditions (short neck: 83.3%, overweight or obese: 88.9%). Median time to completion was 11 days after intubation, with an average duration of 7minutes. The procedure was technically compliant in 83.3% of cases, and considered easy (on self-assessment) in 72.2%, with 2 minor per-procedural complications. No crossover to surgery was required. There was only 1 major post-procedural complication (late hemorrhage). CONCLUSION: This study showed the feasibility of percutaneous tracheostomy by an ENT physician under COVID-19 biohazard conditions. The technique was fast, easy and safe and met safety requirements for patient and staff.

French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic.

Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.

Vacuum-assisted closure (VAC) for craniocerebral wounds in severely injured patients: technical note of a damage control procedure.

The management of a craniocerebral wound (CCW) remains challenging, particularly in a severely injured patient. Considering the complexity of the multilayer insult and damage control care in an unstable patient, every procedure performed should promptly benefit the patient. We report an illustrative case of a patient with a gunshot wound to the head that resulted in a CCW for which we applied vacuum-assisted closure (VAC) therapy according to damage control principles. We describe the technical approach and discuss the indications, results and technique by considering the literature available. VAC can be used for CCWs, particularly for large defects in selected patients according to clinical and CT evaluations following immediate resuscitation. In severely injured and unstable patients, VAC aims to delay definitive reconstructive and time-consuming treatment. Interestingly, it appears to be a safe treatment based on the previously described-but not exclusively trauma-cases with no secondary cerebrospinal fluid leakage encountered.

Hospital care in severe trauma: Initial strategies and life-saving surgical procedures.

Severe trauma patients should be received at the hospital by a multidisciplinary team directed by a "trauma leader" and all institutions capable of receiving such patients should be well organized. As soon as the patient is accepted for care, the entire team should be prepared so that there is no interruption in the pre-hospital chain of care. All caregivers should thoroughly understand the pre-established protocols of diagnostic and therapeutic strategies to allow optimal management of unstable trauma victims in whom hemostasis must be obtained as soon as possible to decrease the morbid consequences of post-hemorrhagic shock. In patients with acute respiratory, circulatory or neurologic distress, several surgical procedures must be performed without delay by whichever surgeon is on call. Our goal is to describe these salvage procedures including invasive approaches to the upper respiratory tract, decompressive thoracostomy, hemostatic or resuscitative thoracotomy, hemostatic laparotomy, preperitoneal pelvic packing, external pelvic fixation by a pelvi-clamp, decompressive craniotomy. All of these procedures can be performed by all practitioners but they require polyvalent skills and training beforehand.

[Covering of parotid and cervical lymph nodes metastasis of cutaneous squamous cell carcinoma of the head, about 18 cases]. / Prise en charge des métastases cervico-parotidiennes des carcinomes épidermoides de la face, discussion à partir d'une série de cas.

AIM: To describe 18 cases of patients treated for advanced cutaneous squamous cell carcinoma (CSCC) of the head metastasing to cervical lymph nodes and parotid gland. To estimate their survival and the risk factors of metastases. PATIENTS AND METHODS: 18 cases of patients affected by CSCC of the head, metastatic to parotid and cervical lymph nodes were afterward analyzed. Two populations were differentiated: the patients already treated for their CSCC, with secondary appearance of metastases in the Population A, the patients by whom the metastase is concomitantly discovered to the CSCC in the Population B. RESULTS: The treatment consisted of a parotidectomy and neck dissection, possibly associated with excision of the primary tumour. Adjuvant radiotherapy was systematic. Metastatic progression was on lungs most of the time (57%), in patients of the population B (80%), or of whom primitive CSCC was of bad forecast (group 2) (78%). The mortality was bound to the complications induced by distant metastases (63%), at 5 years it was superior in the population B (100%) than in the population A (77%). CONCLUSION: CSCC of the head, metastatic to parotid and cervical lymph nodes have a severe prognosis for survival in spite of an optimal curative treatment applied to fragile old patients.

[Multiple intracranial epidermoid cysts: Case report].

Epidermoid cyst is a benign and rare tumor, that evolves slowly. We describe the case of a 55 years-old woman, who came to our consultation for atypical trigeminal neuralgia of left V1 and V2 nerves. Brain MRI found two tumors: T1W hypointense with no appreciable enhancement after gadolinium injection and T2W and diffusion hyperintense. This last feature was in favour of an epidermoid cyst, but the multiplicity of cerebral lesions was definitely not in favor of such a diagnos­tic. They were located behind the right eye and in the left Meckel's cave (trigeminal cave). The surgical strategy consis­ted in removal the retro orbital tumor witch was the most acces­si­ble of both the diagnostic of epidermoid cyst was retaned thanks to the anatomopathology report. As these lesions had the exact same characteristics, we concluded that they were simi­lar. The second epidermoid cyst was not removed because of surgical risk, its benign nature and low evolutionary potential.

[Sarcoidosis of the thyroid: A case report]. / La sarcoïdose thyroïdienne: à propos d'un cas.

OBJECTIVE: To present a case of thyroid sarcoidosis revealed by a multinodular goiter and cervical and mediastinal adenopathies. METHODS: We summarize the clinical presentation of a thyroid sarcoidosis. A review of literature regarding this topic is also presented. RESULTS: A 48-year-old woman presented dysphagia without dyspnea. Clinical and radiological explorations find a multinodular goiter with cervical and mediastinal adenopathies. The symptomatic side of the goiter and the association with adenopathies justify the surgery. Total thyroidectomy and mediastinal lymphadenectomy are processed. Histopathological examination of the thyroid reveal a goiter without malignity, a vesicular nodule, and non necrotizing granulomas consistent with sarcoidosis, as in the adenopathy. CONCLUSION: The interest here, is the difficulty to make the diagnostic without histopathology, between a thyroid cancer with lymphadenopathies and extrapulmonary sarcoidosis (involving thyroid and adenopathies).

[A post-styloid mass revealing a parapharyngeal schwannoma]. / Une masse rétro-stylienne révéatrice d'un schwannome parapharyngé.

INTRODUCTION: The schwannoma of the glossopharyngeal nerve is a rare etiology among the tumor masses developed in the parapharyngeal space. CASE REPORT: We report the case of a 33 years old woman in whom a large schwannoma of the left glossopharyngeal nerve was discovered incidentally on a brain MRI. Respiratory evolutionary prognosis imposed trans-oral surgical treatment. DISCUSSION: We discuss the diagnostic and therapeutic strategy for the benign tumors of the parapharyngeal space. CONCLUSION: The schwannoma of the glossopharyngeal nerve is a benign rare lesion. The difficulty lies on the surgical strategy and the choice of the approach. The functional suites are marked by difficulty swallowing and require intensive speech therapy.

[Role of positron emission tomography and CT with 18F-FDG PET-CT in follow-up of patients treated for head and neck squamous cell carcinoma]. / Place de la 18F-FDG TEP-TDM dans la surveillance post-thérapeutique des carcinomes épidermoïdes des voies aérodigestives supérieures.

The authors in this article, made from a review of the scientific literature (PubMed search engine), indicate the current position of positron emission tomography with 18F-fluro-2-deoxy-D-glucose coupled computed tomography (PET-CT) in the early and late post-treatment follow up of squamous cell carcinomas of the upper aerodigestive tract. The aim of this follow up is twofold: Early detection of locoregional progressive evolution or metastatic progression and search for a possible second metachronous cancer in patients at risk.

[Diagnosis and treatment of post-traumatic perilymphatic fistula: Report of 16 cases]. / Diagnostic et traitement des fistules périlymphatiques post-traumatiques : à propos de 16 cas.

INTRODUCTION: When facing cochleovestibular symptoms such as hearing loss, dizziness or unsteadiness, or a tinnitus evolving in the aftermath of a cranial trauma or overpressure in the form of inner ear barotrauma after diving or a from blast, a perilymphatic fistula must be considered. MATERIALS AND METHODS: We present a homogenous prospective series of 16 cases of perilymphatic fistulae occurring after head trauma or overpressure between 2003 and 2011. Patients suspected of suffering from a perilymphatic fistula and presenting with the following criteria were included: the occurrence after a variable delay of cochleovestibular symptoms (vertigo, tinnitus, and hearing loss) in the aftermath of a head trauma or overpressure. All patients received medical treatment with intravenous corticosteroids. Failure of the initial treatment and in the presence of clinical data suggesting a perilymphatic fistula, an exploration of the middle ear was performed. RESULTS: 13 patients (81.2% underwent surgical exploration with early and stable subtotal recovery of hearing in 90%, a rapid disappearance of vertigo in 89.9%, a loss of tinnitus in 45% and in 27% improvement. CONCLUSION: The diagnosis must be supported by various diagnostic tests. If evidence in favor of a perilymphatic fistula is credible, surgery has always achieved an excellent functional outcome.